Occurrence and removal of psychiatric pharmaceuticals in the Tehran South Municipal Wastewater Treatment Plant

Psychiatric drugs released by humans in wastewater have received more attention because of their potential risks for aquatic organisms. In this study, the occurrence of the two most common groups of psychiatric drugs (sedatives-hypnotics-anxiolytics and antidepressants) were evaluated in the Tehran South Municipal Wastewater Treatment Plant. All the target sedatives-hypnotics-anxiolytics (alprazolam, phenobarbital, and thioridazine) and antidepressants (fluoxetine, citalopram, sertraline, and venlafaxine) were observed in influent and secondary clarification (SC) effluent. Thioridazine (164.25 ± 218.74 ng/L) and citalopram (672.53 ± 938.56 ng/L) had the highest mean concentrations in the influent, while alprazolam (5.09 ± 2.33 ng/L) and citalopram (776.97 ± 1088.01 ng/L) had the highest concentrations in the SC effluent. The higher concentrations of the psychiatric drugs, except thioridazine, were detected in the SC effluent compared to the concentrations in the influent. The increased drugs concentrations, with negative removal efficiencies, were more distinctive in the cold season samples. Psychiatric drugs processed in the chlorination unit followed a completely different pattern compared to the drugs in the biological treatment unit. All the drugs' concentrations, except thioridazine, decreased in the chlorination unit, ranging between 27 ± 14% for alprazolam and 75 ± 10% for citalopram. However, the mean concentrations of the detected drugs were as follows: sertraline (11.96 ± 11.62 ng/L) and venlafaxine (184.94 ± 219.74 ng/L) which could cause environmental and ecological concerns.

Clinical Trials with Melleril (TP21) in the Treatment of Schizophrenia

The authors undertook to investigate the effects of two new phenothiazine derivatives on schizophrenic patients. Over a period of two years a series of clinical trials have been carried out on approximately 260 patients, some controlled, some uncontrolled. These drugs, known as Melleril (TP21) and KS75 are chemically related. Although Melleril was ultimately selected as the drug of choice we have, for statistical reasons, included some of the findings with KS75.

Experience with Thioridazine (“Melleril”) Therapy

“A doctor must know not only the virtue of a drug, but also its drawbacks”—

Carling (1960).

Thioridazine is one of the newer phenothiazine derivatives used in psychiatry. Previous workers have reported few serious side-effects with it. The following pilot trial was carried out on male patients suffering from chronic schizophrenia who required nursing in a closed ward.

A Controlled Study of the Use of Thioridazine in the Treatment of Hyperactive and Aggressive Children in a Children's Psychiatric Hospital

Studies on the use of thioridazine in adults and children were reviewed and the paucity of the controlled objective investigated, observed.

Thioridazine in doses of 25 mg. t.i.d. was administered to nine children with persistent marked aggressivity and hyper-activity. A double-blind study revealed a considerable reduction in aggressive, destructive and hyperactive behaviour. Status epilepticus occurred in an epileptic boy, necessitating an increase in anticonvulsant medication. No other side effects were observed.

It is concluded that thioridazine is a safe and useful drug in the treatment of hyperactive, aggressive, destructive patterns of behaviour in children.

Effect of Phenothiazines on the Thinking of Acute Schizophrenics

Thirty-seven acute schizophrenic patients were given a test measuring the extent to which associatively linked distractors intruded themselves inappropriately into the generation of concepts. This test was given both upon admission to the hospital and after 6 wk. of treatment with Chlorpromazine, Fluphenazine, Thioridazine or placebo. Fluphenazine and Thioridazine produced a decrement in distractor-produced errors greater than that resulting from placebo. Changes produced by Chlorpromazine did not differ significantly from those of the placebo condition. There was a trend for Fluphenazine to be somewhat more effective than was Chlorpromazine. It was pointed out that, while both Fluphenazine and Thioridazine differ in chemical structure from Chlorpromazine, they differ markedly from each other. Some factors possibly accounting for the effectiveness of Fluphenazine were discussed, but such explanations could not be reconciled with the effectiveness of Thioridazine.

[Mechanism of thioridazine plus medroxyprogesterone in the treatment of endometrial cancer]

OBJECTIVE

To explore the in vitro effects of thioridazine (THIO) plus medroxyprogesterone (MPA) on the proliferation and apoptosis of endometrial cancer cell lines (Ishikawa & KLE) and examine the mechanism in the treatment of endometrial cancer.

METHODS

CCK-8 assay was employed for detecting the influence of THIO plus MPA on the proliferation and apoptosis of endometrial cancer cells (ISK & KLE). And the concentration and timepoints of drugs were determined according to the results. Real-time polymerase chain reaction (PCR) and Western blot were used to detect the expression levels of PRB, DRD2 and p-AKT/AKT in PI3K/AKT signal pathway. Flow cytometry was applied for detecting the apoptosis of combination (THIO+MPA) and MPA groups.

RESULTS

Compared to MPA group, the proliferation inhibiting effect of combination group increased significantly in ISK and KLE cells (52.5% ± 2.6% vs 37.3% ± 0.3%, P < 0.05; 97.7% ± 0.7% vs 50.0% ± 0.4%, P < 0.001); the apoptotic rates increased (34.0% ± 1.4% vs 50.5% ± 2.4%, P < 0.01; 5.5% ± 3.6% vs 11.3% ± 0.7%, P < 0.01); the expression levels of PRB and DRD2 were up-regulated (all P < 0.05). And the ratio of p-AKT/AKT decreased obviously.

CONCLUSION

Thioridazine significantly enhances the effects of MPA on proliferative inhibition and apoptotic promotion in endometrial cancer cells. And it may be associated with the PRB/DRD2-mediated PI3K/AKT signal pathway.

Immunophenotypic heterogeneity of primary sinonasal melanoma with aberrant expression of neuroendocrine markers and calponin

Primary sinonasal melanoma is an aggressive tumor that often presents a diagnostic challenge owing to its rarity and variable morphology. Unusual immunophenotypic expression of sinonasal melanoma compounds the problem particularly in a limited tissue sample. We studied immunohistochemical patterns of 5 primary sinonasal melanoma using antibodies against pan-cytokeratin, S-100, HMB-45, Melan-A, chromogranin, synaptophysin, neurofilament protein, and calponin and correlated these patterns with histologic appearance. Sinus/nasal mucosa from non-neoplastic cases were stained for Melan-A to evaluate prevalence of melanocytes in the benign mucosa in comparison to the staining pattern of the mucosa adjacent to the tumor. Similar to previous report, small cell pattern appeared to be over represented in the sinonasal melanoma. Small cell population in 4 cases was almost devoid of pigment, and also was either completely negative or only focally positive for S-100. Three cases stained positive for neuroendocrine markers and neurofilament protein bringing olfactory neuroblastoma and small cell neuroendocrine carcinoma in as differential diagnosis. Three cases were focally positive for calponin without spindle cell morphology or desmoplastic reaction. Immunophenotypic heterogeneity along with the unconventional histomorphology of sinonasal melanoma compounds diagnostic problem and warrants a precautionary approach to avoid misinterpretation. It is necessary to apply a broad panel of immunohistochemistry for the purpose of screening when sinonasal melanoma is considered as a differential diagnosis.

TRANQUILLIZING AND HYPOTENSIVE ACTIVITIES OF TWELVE PHENOTHIAZINES

Twelve phenothiazine derivatives have been compared in relation to their central sedative, tranquillizing and hypotensive activities. The ED50's of the compounds to suppress the conditioned response, unconditioned response and forced locomotor activity were determined. Suppressions of the conditioned and unconditioned responses were taken as criteria for tranquillizing and central sedative activities respectively. The "tranquillizing ratio" (ED50 for unconditioned response/ED50 for conditioned response) was used as the criterion of tranquillizing activity in relation to sedative activity and for purposes of comparison this ratio was assigned a value of unity for chlorpromazine. Perphenazine was the most potent drug in suppressing the conditioned and unconditioned responses whereas fluopromazine had the maximal "tranquillizing index" activity. Six compounds had great, three moderate and three mild hypotensive activity when doses of 1 mg/kg were injected intravenously into dogs. The relationship of the chemical structure to the central sedative activity is discussed.

THE EFFECT OF SOME PHENOTHIAZINE TRANQUILLIZERS ON THE OESTROUS CYCLE OF ALBINO MICE

The effects of reserpine and of nine phenothiazine compounds on the oestrous cycle of albino mice were tested. With the exception of promethazine (which is not a tranquillizer) all the phenothiazine compounds and reserpine prolonged the oestrous cycle. The mechanism by which these tranquillizers interfere with the oestrous cycle is discussed.

STUDIES ON THE HYPERGLYCAEMIA INDUCED BY CHLORPROMAZINE IN RATS

Chlorpromazine induces in rats a marked and long-lasting hyperglycaemia which (a) is more marked at low than high room temperatures, (b) is inhibited by phentolamine but not by dibenamine, and (c) is prevented by adrenalectomy, by removal of the adrenal medullae and by treatment of the rats with reserpine. Other experimental results suggest that there is a correlation between the hyperglycaemia and the hypothermia induced by chlorpromazine and by its congeners. The hyperglycaemia seems to be the result of at least two factors: an activation of the adrenergic mechanisms and an impaired peripheral utilization of glucose.

ANTI-EMETIC ACTIVITY OF PHENOTHIAZINES IN RELATION TO THEIR CHEMICAL STRUCTURE

Twelve phenothiazine derivatives have been studied for anti-emetic potency in dogs against emesis induced by apomorphine. The PD(50)s of all the compounds were determined and the activities compared with chlorpromazine hydrochloride as standard. Thioproperazine methanesulphonate was 300 times more active than chlorpromazine hydrochloride and twice as active as perphenazine sodium citrate. The anti-emetic activity of the compounds has been correlated with their chemical structure.